Clinical psychologyClinical psychology is an integration of science, theory and clinical
knowledge for the purpose of understanding, preventing, and relieving
psychologically-based distress or dysfunction and to promote
subjective well-being and personal development.[1][2] Central to its
practice are psychological assessment, clinical formulation, and
psychotherapy, although clinical psychologists also engage in
research, teaching, consultation, forensic testimony, and program
development and administration.[3] In many countries, clinical
psychology is a regulated mental health profession.
The field is generally considered to have begun in 1896 with the
opening of the first psychological clinic at the
UniversityUniversity of
Pennsylvania by Lightner Witmer. In the first half of the 20th
century, clinical psychology was focused on psychological assessment,
with little attention given to treatment. This changed after the 1940s
when
World War IIWorld War II resulted in the need for a large increase in the
number of trained clinicians. Since that time, three main educational
models have developed in the USA—the Ph.D. Clinical Science model
(heavily focused on research),[4] the Ph.D. science-practitioner model
(integrating research and practice), and the Psy.D.
practitioner-scholar model (focusing on clinical practice). In the UK
the Clinical
PsychologyPsychologyDoctorateDoctorate falls between the latter two of
these models, whilst in much of mainland Europe the training is at
masters level and predominantly psychotherapeutic. Clinical
psychologists are expert in providing psychotherapy, and generally
train within four primary theoretical orientations—psychodynamic,
humanistic, cognitive behavioral therapy (CBT), and systems or family
therapy.

Many 18th c. treatments for psychological distress were based on
pseudo-scientific ideas, such as Phrenology.

The earliest recorded approaches to assess and treat mental distress
were a combination of religious, magical and/or medical
perspectives.[5] Early examples of such physicians included
Patañjali, Padmasambhava,[6] Rhazes, Avicenna,[7] and Rumi.[8] In the
early 19th century, one approach to study mental conditions and
behavior was using phrenology, the study of personality by examining
the shape of the skull. Other popular treatments at that time included
the study of the shape of the face (physiognomy) and Mesmer's
treatment for mental conditions using magnets (mesmerism).
SpiritualismSpiritualism and Phineas Quimby's "mental healing" were also
popular.[9]
While the scientific community eventually came to reject all of these
methods for treating mental illness, academic psychologists also were
not concerned with serious forms of mental illness. The study of
mental illness was already being done in the developing fields of
psychiatry and neurology within the asylum movement.[5] It was not
until the end of the 19th century, around the time when Sigmund Freud
was first developing his "talking cure" in Vienna, that the first
scientific application of clinical psychology began.
Early clinical psychology[edit]

Cover of The Psychological Clinic, the first journal of clinical
psychology, published in 1907 by Lightner Witmer

By the second half of the 1800s, the scientific study of psychology
was becoming well established in university laboratories. Although
there were a few scattered voices calling for an applied psychology,
the general field looked down upon this idea and insisted on "pure"
science as the only respectable practice.[5] This changed when
Lightner WitmerLightner Witmer (1867–1956), a past student of
WundtWundt and head of the
psychology department at the
UniversityUniversity of Pennsylvania, agreed to
treat a young boy who had trouble with spelling. His successful
treatment was soon to lead to Witmer's opening of the first
psychological clinic at Penn in 1896, dedicated to helping children
with learning disabilities.[10] Ten years later in 1907, Witmer was to
found the first journal of this new field, The Psychological Clinic,
where he coined the term "clinical psychology", defined as "the study
of individuals, by observation or experimentation, with the intention
of promoting change".[11] The field was slow to follow Witmer's
example, but by 1914, there were 26 similar clinics in the U.S.[12]
Even as clinical psychology was growing, working with issues of
serious mental distress remained the domain of psychiatrists and
neurologists.[13] However, clinical psychologists continued to make
inroads into this area due to their increasing skill at psychological
assessment. Psychologists' reputation as assessment experts became
solidified during
World War IWorld War I with the development of two intelligence
tests, Army Alpha and Army Beta (testing verbal and nonverbal skills,
respectively), which could be used with large groups of
recruits.[9][10] Due in large part to the success of these tests,
assessment was to become the core discipline of clinical psychology
for the next quarter century, when another war would propel the field
into treatment.
Early professional organizations[edit]
The field began to organize under the name "clinical psychology" in
1917 with the founding of the American Association of Clinical
Psychology. This only lasted until 1919, after which the American
Psychological Association (founded by
G. Stanley HallG. Stanley Hall in 1892)
developed a section on Clinical Psychology, which offered
certification until 1927.[12] Growth in the field was slow for the
next few years when various unconnected psychological organizations
came together as the American Association of Applied
PsychologyPsychology in
1930, which would act as the primary forum for psychologists until
after
World War IIWorld War II when the APA reorganized.[14] In 1945, the APA
created what is now called Division 12, its division of clinical
psychology, which remains a leading organization in the field.
Psychological societies and associations in other English-speaking
countries developed similar divisions, including in Britain, Canada,
Australia and New Zealand.
World War IIWorld War II and the integration of treatment[edit]
When
World War IIWorld War II broke out, the military once again called upon
clinical psychologists. As soldiers began to return from combat,
psychologists started to notice symptoms of psychological trauma
labeled "shell shock" (eventually to be termed posttraumatic stress
disorder) that were best treated as soon as possible.[10] Because
physicians (including psychiatrists) were over-extended in treating
bodily injuries, psychologists were called to help treat this
condition.[15] At the same time, female psychologists (who were
excluded from the war effort) formed the National Council of Women
Psychologists with the purpose of helping communities deal with the
stresses of war and giving young mothers advice on child rearing.[11]
After the war, the
Veterans AdministrationVeterans Administration in the U.S. made an
enormous investment to set up programs to train doctoral-level
clinical psychologists to help treat the thousands of veterans needing
care. As a consequence, the U.S. went from having no formal university
programs in clinical psychology in 1946 to over half of all Ph.D.s in
psychology in 1950 being awarded in clinical psychology.[11]
WWII helped bring dramatic changes to clinical psychology, not just in
America but internationally as well. Graduate education in psychology
began adding psychotherapy to the science and research focus based on
the 1947 scientist-practitioner model, known today as the Boulder
Model, for Ph.D. programs in clinical psychology.[16] Clinical
psychology in Britain developed much like in the U.S. after WWII,
specifically within the context of the National Health Service[17]
with qualifications, standards, and salaries managed by the British
Psychological Society.[18]
Development of the Doctor of
PsychologyPsychology degree[edit]
By the 1960s, psychotherapy had become embedded within clinical
psychology, but for many the Ph.D. educational model did not offer the
necessary training for those interested in practice rather than
research. There was a growing argument that said the field of
psychology in the U.S. had developed to a degree warranting explicit
training in clinical practice. The concept of a practice-oriented
degree was debated in 1965 and narrowly gained approval for a pilot
program at the
University of IllinoisUniversity of Illinois starting in 1968.[19] Several
other similar programs were instituted soon after, and in 1973, at the
Vail Conference on Professional Training in Psychology, the
practitioner–scholar model of clinical psychology—or Vail
Model—resulting in the Doctor of
PsychologyPsychology (Psy.D.) degree was
recognized.[20] Although training would continue to include research
skills and a scientific understanding of psychology, the intent would
be to produce highly trained professionals, similar to programs in
medicine, dentistry, and law. The first program explicitly based on
the
Psy.D. model was instituted at Rutgers University.[19] Today,
about half of all American graduate students in clinical psychology
are enrolled in
Psy.D. programs.[20]
A changing profession[edit]
Since the 1970s, clinical psychology has continued growing into a
robust profession and academic field of study. Although the exact
number of practicing clinical psychologists is unknown, it is
estimated that between 1974 and 1990, the number in the U.S. grew from
20,000 to 63,000.[21]
Clinical psychologistsClinical psychologists continue to be experts in
assessment and psychotherapy while expanding their focus to address
issues of gerontology, sports, and the criminal justice system to name
a few. One important field is health psychology, the fastest-growing
employment setting for clinical psychologists in the past decade.[9]
Other major changes include the impact of managed care on mental
health care; an increasing realization of the importance of knowledge
relating to multicultural and diverse populations; and emerging
privileges to prescribe psychotropic medication.
Professional practice[edit]
Clinical psychologistsClinical psychologists engage in a wide range of activities. Some
focus solely on research into the assessment, treatment, or cause of
mental illness and related conditions. Some teach, whether in a
medical school or hospital setting, or in an academic department
(e.g., psychology department) at an institution of higher education.
The majority of clinical psychologists engage in some form of clinical
practice, with professional services including psychological
assessment, provision of psychotherapy, development and administration
of clinical programs, and forensics (e.g., providing expert testimony
in a legal proceeding.[11]
In clinical practice, clinical psychologists may work with
individuals, couples, families, or groups in a variety of settings,
including private practices, hospitals, mental health organizations,
schools, businesses, and non-profit agencies. Clinical psychologists
who provide clinical services may also choose to specialize. Some
specializations are codified and credentialed by regulatory agencies
within the country of practice.[22] In the United States such
specializations are credentialed by the American Board of Professional
PsychologyPsychology (ABPP).
Training and certification to practice[edit]

Clinical psychologistsClinical psychologists study a generalist program in psychology plus
postgraduate training and/or clinical placement and supervision. The
length of training differs across the world, ranging from four years
plus post-Bachelors supervised practice[23] to a doctorate of three to
six years which combines clinical placement.[24] In the USA, about
half of all clinical psychology graduate students are being trained in
Ph.D. programs—a model that emphasizes research—with the other
half in
Psy.D. programs, which has more focus on practice (similar to
professional degrees for medicine and law).[20] Both models are
accredited by the American Psychological Association[25] and many
other English-speaking psychological societies. A smaller number of
schools offer accredited programs in clinical psychology resulting in
a Masters degree, which usually take two to three years
post-Bachelors.
In the U.K., clinical psychologists undertake a Doctor of Clinical
PsychologyPsychology (D.Clin.Psych.), which is a practitioner doctorate with
both clinical and research components. This is a three-year full-time
salaried program sponsored by the
National Health ServiceNational Health Service (NHS) and
based in universities and the NHS. Entry into these programs is highly
competitive, and requires at least a three-year undergraduate degree
in psychology plus some form of experience, usually in either the NHS
as an Assistant
PsychologistPsychologist or in academia as a
ResearchResearch Assistant.
It is not unusual for applicants to apply several times before being
accepted onto a training course as only about one-fifth of applicants
are accepted each year.[26] These clinical psychology doctoral degrees
are accredited by the
British Psychological Society and the Health
Professions Council (HPC). The HPC is the statutory regulator for
practitioner psychologists in the UK. Those who successfully complete
clinical psychology doctoral degrees are eligible to apply for
registration with the HPC as a clinical psychologist.
The practice of clinical psychology requires a license in the United
States, Canada, the United Kingdom, and many other countries. Although
each of the U.S. states is somewhat different in terms of requirements
and licenses, there are three common elements:[27]

Graduation from an accredited school with the appropriate degree
Completion of supervised clinical experience or internship
Passing a written examination and, in some states, an oral examination

All U.S. state and Canadian province licensing boards are members of
the Association of State and Provincial
PsychologyPsychology Boards (ASPPB)
which created and maintains the Examination for Professional Practice
in
PsychologyPsychology (EPPP). Many states require other examinations in
addition to the EPPP, such as a jurisprudence (i.e. mental health law)
examination and/or an oral examination.[27] Most states also require a
certain number of continuing education credits per year in order to
renew a license, which can be obtained though various means, such as
taking audited classes and attending approved workshops. Clinical
psychologists require the
PsychologistPsychologist license to practice, although
licenses can be obtained with a masters-level degree, such as Marriage
and Family Therapist (MFT),
Licensed Professional Counselor (LPC), and
Licensed Psychological Associate (LPA).[28]
In the U.K. registration as a clinical psychologist with the Health
Professions Council (HPC) is necessary. The HPC is the statutory
regulator for practitioner psychologists in the U.K. In the U.K. the
following titles are restricted by law "registered psychologist" and
"practitioner psychologist"; in addition the specialist title
"clinical psychologist" is also restricted by law.
Assessment[edit]
An important area of expertise for many clinical psychologists is
psychological assessment, and there are indications that as many as
91% of psychologists engage in this core clinical practice.[29] Such
evaluation is usually done in service to gaining insight into and
forming hypotheses about psychological or behavioral problems. As
such, the results of such assessments are usually used to create
generalized impressions (rather than diagnoses) in service to
informing treatment planning. Methods include formal testing measures,
interviews, reviewing past records, clinical observation, and physical
examination.[2]
Measurement domains[edit]
There exist hundreds of various assessment tools, although only a few
have been shown to have both high validity (i.e., test actually
measures what it claims to measure) and reliability (i.e.,
consistency). These measures generally fall within one of several
categories, including the following:

IntelligenceIntelligence & achievement tests – These tests are designed to
measure certain specific kinds of cognitive functioning (often
referred to as IQ) in comparison to a norming-group. These tests, such
as the WISC-IV, attempt to measure such traits as general knowledge,
verbal skill, memory, attention span, logical reasoning, and
visual/spatial perception. Several tests have been shown to predict
accurately certain kinds of performance, especially scholastic.[29]
Personality tests – Tests of personality aim to describe patterns of
behavior, thoughts, and feelings. They generally fall within two
categories: objective and projective. Objective measures, such as the
MMPI, are based on restricted answers—such as yes/no, true/false, or
a rating scale—which allow for computation of scores that can be
compared to a normative group. Projective tests, such as the Rorschach
inkblot test, allow for open-ended answers, often based on ambiguous
stimuli, presumably revealing non-conscious psychological dynamics.
Neuropsychological tests –
Neuropsychological tests consist of
specifically designed tasks used to measure psychological functions
known to be linked to a particular brain structure or pathway. They
are typically used to assess impairment after an injury or illness
known to affect neurocognitive functioning, or when used in research,
to contrast neuropsychological abilities across experimental groups.
Clinical observation –
Clinical psychologistsClinical psychologists are also trained to
gather data by observing behavior. The clinical interview is a vital
part of assessment, even when using other formalized tools, which can
employ either a structured or unstructured format. Such assessment
looks at certain areas, such as general appearance and behavior, mood
and affect, perception, comprehension, orientation, insight, memory,
and content of communication. One psychiatric example of a formal
interview is the mental status examination, which is often used in
psychiatry as a screening tool for treatment or further testing.[29]

Diagnostic impressions[edit]
See also: Mental disorder

Published by the American Psychiatric Association, the Diagnostic and
Statistical Manual of Mental Disorders (DSM) provides a common
language and standard criteria for the classification of mental
disorders.

After assessment, clinical psychologists may provide a diagnostic
impression. Many countries use the International Statistical
Classification of Diseases and Related Health Problems (ICD-10) while
the U.S. most often uses the Diagnostic and Statistical Manual of
Mental Disorders. Both are nosological systems that largely assume
categorical disorders diagnosed through the application of sets of
criteria including symptoms and signs.[30]
Several new models are being discussed, including a "dimensional
model" based on empirically validated models of human differences
(such as the five factor model of personality[30][31]) and a
"psychosocial model", which would take changing, intersubjective
states into greater account.[32] The proponents of these models claim
that they would offer greater diagnostic flexibility and clinical
utility without depending on the medical concept of illness.[citation
needed] However, they also admit that these models are not yet robust
enough to gain widespread use, and should continue to be
developed.[citation needed]
Clinical psychologistsClinical psychologists do not tend to diagnose, but rather use
formulation—an individualized map of the difficulties that the
patient or client faces, encompassing predisposing, precipitating and
perpetuating (maintaining) factors.[33]
Clinical v. mechanical prediction[edit]
Clinical assessment can be characterized as a prediction problem where
the purpose of assessment is to make inferences (predictions) about
past, present, or future behavior.[34] For example, many therapy
decisions are made on the basis of what a clinician expects will help
a patient make therapeutic gains. Once observations have been
collected (e.g., psychological test results, diagnostic impressions,
clinical history, X-ray, etc.), there are two mutually exclusive ways
to combine those sources of information to arrive at a decision,
diagnosis, or prediction. One way is to combine the data in an
algorithmic, or "mechanical" fashion. Mechanical prediction methods
are simply a mode of combination of data to arrive at a
decision/prediction of behavior (e.g., treatment response). Mechanical
prediction does not preclude any type of data from being combined; it
can incorporate clinical judgments, properly coded, in the
algorithm.[34] The defining characteristic is that, once the data to
be combined is given, the mechanical approach will make a prediction
that is 100% reliable. That is, it will make exactly the same
prediction for exactly the same data every time. Clinical prediction,
on the other hand, does not guarantee this, as it depends on the
decision-making processes of the clinician making the judgment, their
current state of mind, and knowledge base.[35] [34]
What has come to be called the "clinical versus statistical
prediction" debate was first described in detail in 1954 by Paul
Meehl,[35] where he explored the claim that mechanical (formal,
algorithmic) methods of data combination could outperform clinical
(e.g., subjective, informal, "in the clinician's head") methods when
such combinations are used to arrive at a prediction of behavior.
Meehl concluded that mechanical modes of combination performed as well
or better than clinical modes.[36] Subsequent meta-analyses of studies
that directly compare mechanical and clinical predictions have born
out Meehl's 1954 conclusions.[37][38] A 2009 survey of practicing
clinical psychologists found that clinicians almost exclusively use
their clinical judgment to make behavioral predictions for their
patients, including diagnosis and prognosis.[39]
Intervention[edit]
Main article: Psychotherapy
PsychotherapyPsychotherapy involves a formal relationship between professional and
client—usually an individual, couple, family, or small group—that
employs a set of procedures intended to form a therapeutic alliance,
explore the nature of psychological problems, and encourage new ways
of thinking, feeling, or behaving.[2][40]
Clinicians have a wide range of individual interventions to draw from,
often guided by their training—for example, a cognitive behavioral
therapy (CBT) clinician might use worksheets to record distressing
cognitions, a psychoanalyst might encourage free association, while a
psychologist trained in Gestalt techniques might focus on immediate
interactions between client and therapist. Clinical psychologists
generally seek to base their work on research evidence and outcome
studies as well as on trained clinical judgment. Although there are
literally dozens of recognized therapeutic orientations, their
differences can often be categorized on two dimensions: insight vs.
action and in-session vs. out-session.[11]

The methods used are also different in regards to the population being
served as well as the context and nature of the problem. Therapy will
look very different between, say, a traumatized child, a depressed but
high-functioning adult, a group of people recovering from substance
dependence, and a ward of the state suffering from terrifying
delusions. Other elements that play a critical role in the process of
psychotherapy include the environment, culture, age, cognitive
functioning, motivation, and duration (i.e. brief or long-term
therapy).[40][41]
Four main schools[edit]
Many clinical psychologists are integrative or eclectic and draw from
the evidence base across different models of therapy in an integrative
way, rather than using a single specific model.
In the UK, clinical psychologists have to show competence in at least
two models of therapy, including CBT, to gain their doctorate. The
British Psychological Society Division of Clinical
PsychologyPsychology has been
vocal about the need to follow the evidence base rather than being
wedded to a single model of therapy.
In the USA, intervention applications and research are dominated in
training and practice by essentially four major schools of practice:
psychodynamic, humanistic, behavioral/cognitive behavioral, and
systems or family therapy.[2]
Psychodynamic[edit]
Main article: Psychodynamic psychotherapy
The psychodynamic perspective developed out of the psychoanalysis of
Sigmund Freud. The core object of psychoanalysis is to make the
unconscious conscious—to make the client aware of his or her own
primal drives (namely those relating to sex and aggression) and the
various defenses used to keep them in check.[40] The essential tools
of the psychoanalytic process are the use of free association and an
examination of the client's transference towards the therapist,
defined as the tendency to take unconscious thoughts or emotions about
a significant person (e.g. a parent) and "transfer" them onto another
person. Major variations on Freudian psychoanalysis practiced today
include self psychology, ego psychology, and object relations theory.
These general orientations now fall under the umbrella term
psychodynamic psychology, with common themes including examination of
transference and defenses, an appreciation of the power of the
unconscious, and a focus on how early developments in childhood have
shaped the client's current psychological state.[40]
Humanistic[edit]
Main article: Humanistic psychology
Humanistic psychologyHumanistic psychology was developed in the 1950s in reaction to both
behaviorism and psychoanalysis, largely due to the person-centered
therapy of
Carl RogersCarl Rogers (often referred to as Rogerian Therapy) and
existential psychology developed by
Viktor FranklViktor Frankl and Rollo May.[2]
Rogers believed that a client needed only three things from a
clinician to experience therapeutic improvement—congruence,
unconditional positive regard, and empathetic understanding.[42] By
using phenomenology, intersubjectivity and first-person categories,
the humanistic approach seeks to get a glimpse of the whole person and
not just the fragmented parts of the personality.[43] This aspect of
holism links up with another common aim of humanistic practice in
clinical psychology, which is to seek an integration of the whole
person, also called self-actualization. From 1980, Hans-Werner
Gessmann integrated the ideas of humanistic psychology into group
psychotherapy as humanistic psychodrama. [44] According to humanistic
thinking,[45] each individual person already has inbuilt potentials
and resources that might help them to build a stronger personality and
self-concept. The mission of the humanistic psychologist is to help
the individual employ these resources via the therapeutic
relationship.
Behavioral and cognitive behavioral[edit]
Main articles:
Cognitive behavioral therapyCognitive behavioral therapy and Behaviour therapy
Cognitive behavioral therapyCognitive behavioral therapy (CBT) developed from the combination of
cognitive therapy and rational emotive behavior therapy, both of which
grew out of cognitive psychology and behaviorism. CBT is based on the
theory that how we think (cognition), how we feel (emotion), and how
we act (behavior) are related and interact together in complex ways.
In this perspective, certain dysfunctional ways of interpreting and
appraising the world (often through schemas or beliefs) can contribute
to emotional distress or result in behavioral problems. The object of
many cognitive behavioral therapies is to discover and identify the
biased, dysfunctional ways of relating or reacting and through
different methodologies help clients transcend these in ways that will
lead to increased well-being.[46] There are many techniques used, such
as systematic desensitization, socratic questioning, and keeping a
cognition observation log. Modified approaches that fall into the
category of CBT have also developed, including dialectic behavior
therapy and mindfulness-based cognitive therapy.[47]
Behavior therapy is a rich tradition. It is well researched with a
strong evidence base. Its roots are in behaviorism. In behavior
therapy, environmental events predict the way we think and feel. Our
behavior sets up conditions for the environment to feedback back on
it. Sometimes the feedback leads the behavior to increase-
reinforcement and sometimes the behavior decreases- punishment.
Oftentimes behavior therapists are called applied behavior analysts or
behavioral health counselors. They have studied many areas from
developmental disabilities to depression and anxiety disorders. In the
area of mental health and addictions a recent article looked at APA's
list for well established and promising practices and found a
considerable number of them based on the principles of operant and
respondent conditioning.[48] Multiple assessment techniques have come
from this approach including functional analysis (psychology), which
has found a strong focus in the school system. In addition, multiple
intervention programs have come from this tradition including
community reinforcement approach for treating addictions, acceptance
and commitment therapy, functional analytic psychotherapy, including
dialectic behavior therapy and behavioral activation. In addition,
specific techniques such as contingency management and exposure
therapy have come from this tradition.
Systems or family therapy[edit]
Main article: Family therapy
Systems or family therapy works with couples and families, and
emphasizes family relationships as an important factor in
psychological health. The central focus tends to be on interpersonal
dynamics, especially in terms of how change in one person will affect
the entire system.[49] Therapy is therefore conducted with as many
significant members of the "system" as possible. Goals can include
improving communication, establishing healthy roles, creating
alternative narratives, and addressing problematic behaviors.
Other therapeutic perspectives[edit]
See also: List of psychotherapies
There exist dozens of recognized schools or orientations of
psychotherapy—the list below represents a few influential
orientations not given above. Although they all have some typical set
of techniques practitioners employ, they are generally better known
for providing a framework of theory and philosophy that guides a
therapist in his or her working with a client.

Existential – Existential psychotherapy postulates that people are
largely free to choose who we are and how we interpret and interact
with the world. It intends to help the client find deeper meaning in
life and to accept responsibility for living. As such, it addresses
fundamental issues of life, such as death, aloneness, and freedom. The
therapist emphasizes the client’s ability to be self-aware, freely
make choices in the present, establish personal identity and social
relationships, create meaning, and cope with the natural anxiety of
living.[50]

Gestalt -
Gestalt therapy was primarily founded by
Fritz PerlsFritz Perls in the
1950s. This therapy is perhaps best known for using techniques
designed to increase self-awareness, the best-known perhaps being the
"empty chair technique." Such techniques are intended to explore
resistance to "authentic contact", resolve internal conflicts, and
help the client complete "unfinished business".[51]

Postmodern – Postmodern psychology says that the experience of
reality is a subjective construction built upon language, social
context, and history, with no essential truths.[52] Since "mental
illness" and "mental health" are not recognized as objective,
definable realities, the postmodern psychologist instead sees the goal
of therapy strictly as something constructed by the client and
therapist.[53] Forms of postmodern psychotherapy include narrative
therapy, solution-focused therapy, and coherence therapy.
Transpersonal – The transpersonal perspective places a stronger
focus on the spiritual facet of human experience.[54] It is not a set
of techniques so much as a willingness to help a client explore
spirituality and/or transcendent states of consciousness. It also is
concerned with helping clients achieve their highest potential.

Multiculturalism – Although the theoretical foundations of
psychology are rooted in European culture, there is a growing
recognition that there exist profound differences between various
ethnic and social groups and that systems of psychotherapy need to
take those differences into greater consideration.[41] Further, the
generations following immigrant migration will have some combination
of two or more cultures—with aspects coming from the parents and
from the surrounding society—and this process of acculturation can
play a strong role in therapy (and might itself be the presenting
problem). Culture influences ideas about change, help-seeking, locus
of control, authority, and the importance of the individual versus the
group, all of which can potentially clash with certain givens in
mainstream psychotherapeutic theory and practice.[55] As such, there
is a growing movement to integrate knowledge of various cultural
groups in order to inform therapeutic practice in a more culturally
sensitive and effective way.[56]
Feminism –
Feminist therapy is an orientation arising from the
disparity between the origin of most psychological theories (which
have male authors) and the majority of people seeking counseling being
female. It focuses on societal, cultural, and political causes and
solutions to issues faced in the counseling process. It openly
encourages the client to participate in the world in a more social and
political way.[57]
Positive psychologyPositive psychology –
Positive psychologyPositive psychology is the scientific study of
human happiness and well-being, which started to gain momentum in 1998
due to the call of Martin Seligman,[58] then president of the APA. The
history of psychology shows that the field has been primarily
dedicated to addressing mental illness rather than mental wellness.
Applied positive psychology's main focus, therefore, is to increase
one's positive experience of life and ability to flourish by promoting
such things as optimism about the future, a sense of flow in the
present, and personal traits like courage, perseverance, and
altruism.[59][60] There is now preliminary empirical evidence to show
that by promoting Seligman's three components of happiness—positive
emotion (the pleasant life), engagement (the engaged life), and
meaning (the meaningful life)—positive therapy can decrease clinical
depression.[61]

Integration[edit]
Main article: Integrative psychotherapy
In the last couple of decades, there has been a growing movement to
integrate the various therapeutic approaches, especially with an
increased understanding of cultural, gender, spiritual, and
sexual-orientation issues.
Clinical psychologistsClinical psychologists are beginning to
look at the various strengths and weaknesses of each orientation while
also working with related fields, such as neuroscience, behavioral
genetics, evolutionary biology, and psychopharmacology. The result is
a growing practice of eclecticism, with psychologists learning various
systems and the most efficacious methods of therapy with the intent to
provide the best solution for any given problem.[62]
Professional ethics[edit]

The examples and perspective in this article deal primarily with the
United States and do not represent a worldwide view of the subject.
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The field of clinical psychology in most countries is strongly
regulated by a code of ethics. In the U.S., professional ethics are
largely defined by the APA Code of Conduct, which is often used by
states to define licensing requirements. The APA Code generally sets a
higher standard than that which is required by law as it is designed
to guide responsible behavior, the protection of clients, and the
improvement of individuals, organizations, and society.[63] The Code
is applicable to all psychologists in both research and applied
fields.
The APA Code is based on five principles: Beneficence and
Nonmaleficence, Fidelity and Responsibility, Integrity, Justice, and
Respect for People's Rights and Dignity.[63] Detailed elements address
how to resolve ethical issues, competence, human relations, privacy
and confidentiality, advertising, record keeping, fees, training,
research, publication, assessment, and therapy.
In the UK the
British Psychological Society has published a Code of
Conduct and Ethics for clinical psychologists. This has four key
areas: Respect, Competence, Responsibility and Integrity.[64] Other
European professional organisations have similar codes of conduct and
ethics.
Comparison with other mental health professions[edit]
See also:
Mental health professional
Psychiatry[edit]

Fluoxetine hydrochloride, branded by Lilly as Prozac, is a
antidepressant drug prescribed by physicians, psychiatrists, and some
nurses.

Although clinical psychologists and psychiatrists can be said to share
a same fundamental aim—the alleviation of mental distress—their
training, outlook, and methodologies are often quite different.
Perhaps the most significant difference is that psychiatrists are
licensed physicians. As such, psychiatrists often use the medical
model to assess psychological problems (i.e., those they treat are
seen as patients with an illness) and rely on psychotropic medications
as the chief method of addressing the illness[65]—although many also
employ psychotherapy as well. Psychiatrists and medical psychologists
(who are clinical psychologists that are also licensed to prescribe)
are able to conduct physical examinations, order and interpret
laboratory tests and EEGs, and may order brain imaging studies such as
CT or CAT, MRI, and PET scanning.
Clinical psychologistsClinical psychologists generally do not prescribe medication, although
there is a growing movement for psychologists to have prescribing
privileges.[66] These medical privileges require additional training
and education. To date, medical psychologists may prescribe
psychotropic medications in Guam, Iowa, Idaho, Illinois, New Mexico,
Louisiana, the Public Health Service, the Indian Health Service, and
the United States Military.[67]
Counseling psychology[edit]
Counseling psychologists undergo the same level of rigor in study and
use many of the same interventions and tools as clinical
psychologists, including psychotherapy and assessment. Traditionally,
counseling psychologists helped people with what might be considered
normal or moderate psychological problems—such as the feelings of
anxiety or sadness resulting from major life changes or events.[3][11]
However, that distinction has faded over time, and of the counseling
psychologists who do not go into academia (which does not involve
treatment or diagnosis), the majority of counseling psychologists
treat mental illness alongside clinical psychologists. Many counseling
psychologists also receive specialized training in career assessment,
group therapy, and relationship counseling.
Counseling psychologyCounseling psychology as a field values multiculturalism [68] and
social advocacy, often stimulating research in multicultural issues.
There are fewer counseling psychology graduate programs than those for
clinical psychology and they are more often housed in departments of
education rather than psychology. Counseling psychologists tend to be
more frequently employed in university counseling centers compared to
hospitals and private practice for clinical psychologists.[69]
However, counseling and clinical psychologists can be employed in a
variety of settings, with a large degree of overlap (prisons,
colleges, community mental health, non-profits, corporations, private
practice, hospitals and Veterans Affairs). Distinctions between the
two fields continue to fade.

School psychology[edit]
School psychologists are primarily concerned with the academic,
social, and emotional well-being of children and adolescents within a
scholastic environment. In the U.K., they are known as "educational
psychologists". Like clinical (and counseling) psychologists, school
psychologists with doctoral degrees are eligible for licensure as
health service psychologists, and many work in private practice.
Unlike clinical psychologists, they receive much more training in
education, child development and behavior, and the psychology of
learning. Common degrees include the
Educational Specialist Degree
(Ed.S.),
Doctor of PhilosophyDoctor of Philosophy (Ph.D.), and Doctor of Education
(Ed.D.).
Traditional job roles for school psychologists employed in school
settings have focused mainly on assessment of students to determine
their eligibility for special education services in schools, and on
consultation with teachers and other school professionals to design
and carry out interventions on behalf of students. Other major roles
also include offering individual and group therapy with children and
their families, designing prevention programs (e.g. for reducing
dropout), evaluating school programs, and working with teachers and
administrators to help maximize teaching efficacy, both in the
classroom and systemically.[76][77]
Clinical social work[edit]
Social workers provide a variety of services, generally concerned with
social problems, their causes, and their solutions. With specific
training, clinical social workers may also provide psychological
counseling (in the U.S. and Canada), in addition to more traditional
social work. The Masters in Social Work in the U.S. is a two-year,
sixty credit program that includes at least a one-year practicum (two
years for clinicians).[78]
Occupational therapy[edit]
Occupational therapy—often abbreviated OT—is the "use of
productive or creative activity in the treatment or rehabilitation of
physically, cognitively, or emotionally disabled people."[79] Most
commonly, occupational therapists work with people with disabilities
to enable them to maximize their skills and abilities. Occupational
therapy practitioners are skilled professionals whose education
includes the study of human growth and development with specific
emphasis on the physical, emotional, psychological, sociocultural,
cognitive and environmental components of illness and injury. They
commonly work alongside clinical psychologists in settings such as
inpatient and outpatient mental health, pain management clinics,
eating disorder clinics, and child development services. OT's use
support groups, individual counseling sessions, and activity-based
approaches to address psychiatric symptoms and maximize functioning in
life activities.
Criticisms and controversies[edit]
Clinical psychologyClinical psychology is a diverse field and there have been recurring
tensions over the degree to which clinical practice should be limited
to treatments supported by empirical research.[80] Despite some
evidence showing that all the major therapeutic orientations are about
of equal effectiveness,[81][82] there remains much debate about the
efficacy of various forms treatment in use in clinical psychology.[83]
It has been reported that clinical psychology has rarely allied itself
with client groups and tends to individualize problems to the neglect
of wider economic, political and social inequality issues that may not
be the responsibility of the client.[80] It has been argued that
therapeutic practices are inevitably bound up with power inequalities,
which can be used for good and bad.[84] A critical psychology movement
has argued that clinical psychology, and other professions making up a
"psy complex", often fail to consider or address inequalities and
power differences and can play a part in the social and moral control
of disadvantage, deviance and unrest.[85][86]
An October 2009 editorial in the journal Nature suggests that a large
number of clinical psychology practitioners in the United States
consider scientific evidence to be "less important than their personal
– that is, subjective – clinical experience."[87]
See also[edit]

American Academy of Clinical Psychology
American Association for Marriage and Family Therapy
American Board of Professional Psychology
Annual Review of Clinical Psychology
APA Society of Clinical
PsychologyPsychology (Division 12)
PsychologyPsychology Careers Blog Articles and other great content on Careers in
Psychology
Association of State and Provincial
PsychologyPsychology Boards (ASPPB)
Info on the field of psychology form the U.S. Department of Labor,
Bureau of Labor Statistics
International Society of Clinical Psychology
Journal of Clinical Psychiatry
NAMI: National Alliance on Mental Illness
National Institute of Mental Health
PsychologyPsychology definitions